Dealing with a complicated pregnancy that is life-threatening can be an immensely overwhelming experience for the expectant mother. The stress of bearing the child with the knowledge that the baby may not survive the term, and may have to be terminated mid-way, can be emotionally draining and physically exhausting. Pregnancy is a beautiful, life-altering experience, but when it is associated with complications, it can become stressful and depressing.

In terms of pregnancy complications, the rarer the case, the more difficult it is to deal with it. Pregnancy after a hysterectomy is relatively rare and uncommon, but it can happen, and hence, it is essential to understand what causes these conditions and how you can deal with them [1]. More importantly, it is crucial to analyze the options that you have and then select the best possible solution. MomJunction has put together some relevant information on hysterectomy and pregnancy.

What Is Hysterectomy?

A hysterectomy is a surgical procedure to remove the uterus or womb. The uterus is that organ of the female body where the fetus or the baby grows. A hysterectomy may involve total or partial removal of the uterus and other organs and, in which case, the procedure will be either a total or partial hysterectomy.

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Doctors may remove your ovaries, fallopian tubes, but it depends on the need, and your medical assessment. After a hysterectomy, the woman will not have her menstrual periods, and hence, she will be unable to get pregnant [2].

A hysterectomy is permanent and irreversible. Hence, it is best to discuss this procedure at length with your gynecologist. You may want to know other alternatives to hysterectomy, especially if you want to conceive in the future.

Uterus removal will affect your lifestyle and health. Getting the right information before you opt for the surgery will leave you with fewer worries and doubts. Also, armed with the right information, you will be able to analyze your position and take the right steps to lead a normal life after the surgery.

A hysterectomy is a common procedure in the United States. In fact, statistics reveal hysterectomy is the second most common surgery for women in the US after a c-Section. Every year, about 600,000 women opt for a hysterectomy in the US alone [3].

Why Would You Need A Hysterectomy?

As mentioned above, hysterectomy involves removing your womb or uterus. This typically means that doctors opt for a hysterectomy when there is some underlying condition affecting the female reproductive organs. Here are some conditions that can make hysterectomy a necessity:

1. Uterine Fibroids:

Fibroids are non-cancerous growths that reportedly surface out of the walls of the uterus. These fibroids cause immense pain along with heavy bleeding.

2. Unusually Heavy Bleeding:

If you experience heavy bleeding with extreme abdominal pain, it indicates a problem. Heavy menstrual bleeding can occur due to the presence of uterine fibroids. However, in most cases, doctors are unable to find a reason for the excessive bleeding. Under such circumstances, the doctor may recommend a hysterectomy if the woman is not of reproductive age, is unwilling to plan a pregnancy, or if the bleeding and the subsequent hormonal imbalances are disrupting her normal course of life.

3. Uterine Prolapse:

This is a rare condition when the uterus slips from its place and goes down towards the vagina. This condition usually occurs when the woman has several vaginal births. Menopause, pelvic surgery or obesity may also cause uterine prolapse. This condition leads to immense pelvic pressure and also has a significant negative impact on urinary and bowel movements. Removing the uterus is the easiest way to deal with this condition. Also, because the woman experiencing this condition has already given birth or has surpassed her reproductive age, doctors recommend hysterectomy as the most preferred treatment.

4. Endometriosis:

Endometriosis is a condition when the tissues that line the wall of the uterus grow on the exterior wall of the uterus and over the ovaries. This condition causes excruciating abdominal pain as well as bleeding between periods.

5. Adenomyosis:

Adenomyosis is the opposite of endometriosis. Here, the tissues meant to grow on the exterior walls of the uterus grow in the interior walls. This causes the walls of the uterus to become unusually thick, leading to increased bleeding and severe abdominal pain.

6. Uterine Cancer:

Hysterectomy is the best solution if you have a cancerous growth in the uterus, ovaries, cervix or the endometrial wall. While there might be other options available to you such as radiation therapy, chemotherapy, and hysterectomy are recommended when your cancer is at an advanced stage or when the patient is not in a condition to respond to other treatments. This may be because of the age of the patient or because of any other underlying condition when radiations and chemotherapy are not advisable [4].

While these conditions may require a hysterectomy, you can always consult the doctor to identify other alternatives. This is true if you are young and keen on experiencing motherhood later on in life. You have to understand that hysterectomy is a major and life-changing surgery, and it should always be your last resort when everything else fails. Talk to your doctor about all treatment options and also the various outcomes if you do choose to go ahead with the hysterectomy procedure.

Alternatives To Hysterectomy:

Hysterectomy is a surgical procedure to remove your uterus and possibly other reproductive organs. When you opt for this surgery, you will not be able to get pregnant. Most women who must undergo a hysterectomy want to avoid it only because they wish to become pregnant in the future, and they do not want to lose the opportunity to get pregnant.

Sometimes, a hysterectomy may be a necessity. You may be experiencing prolonged bleeding or may have certain cancers that cannot be treated without this procedure. But, if that is not the case, here are some alternatives that you can and should consider:

1. Careful Monitoring:

Uterine fibroids are increasingly becoming commonplace. If you have this condition, you may want to wait and observe the fibroids over time instead of immediately opting for a hysterectomy procedure. In some cases, the fibroids tend to shrink with time or after menopause.

2. Regular Exercise:

For uterine prolapse, exercise can be quite helpful. Kegel exercises can strengthen your pelvic muscles, and this, in turn, can help your condition. Regularly practicing Kegel exercises can hold the uterus in place, and this can be a better way to deal with your condition than opting for a hysterectomy.

3. Medications:

Medications can resolve certain uterus-related issues, like endometriosis, thereby doing away the need to have a hysterectomy. There are over-the-counter medications that you can take to alleviate pain and minimize bleeding during your period. Some oral contraceptive pills or hormone balancing pills can also aid with excessive bleeding.

4. Vaginal Pessary:

A pessary is a rubber or plastic object (usually round or donut shaped) that functions as a birth control measure. A pessary can also be very helpful in dealing with uterine prolapse. It can help keep your uterus in place, and in some cases, it can even push it back to its original position.

5. Surgery:

There might be minor surgeries that you may want to consider instead of opting for the hysterectomy. Depending on your conditions, the surgeries may be the following:

a. Surgery For Treating Endometriosis:

In this surgery, the doctor may make a miniscule incision and perform a laparoscopic surgery to remove the scar and extra tissues growing on the walls of the uterus. It is these tissues that cause endometriosis. You needn’t worry, as this is a minor surgery that will not have any impact on your fertility. You will still be able to get pregnant after the procedure.

b. Surgery To Deal With Heavy And Prolonged Vaginal Bleeding:

Gynecologists will recommend Dilation and Curettage (D&C) to remove polyps or non-cancerous growths on the lining of your uterus. When these polyps grow or rupture, they can result in profuse vaginal bleeding. Also, they are instrumental in cause excessive bleeding during menstruation.

c. Surgery To Remove Uterine Fibroids Without Uterus Removal:

After having this procedure, you will still be able to get pregnant. This surgery is referred to as myomectomy. This surgery is performed either through the pelvic area or the cervix and vagina.

d. Surgery To Shrink The Size Of Uterine Fibroids:

This surgical procedure is known as myolisis. It can be a non-invasive procedure if the surgeon uses a laparoscope. It shaves the fibroids and reduces their size.

Types of Hysterectomy:

A hysterectomy is a hysterectomy, right? Wrong. There are different types of hysterectomy that can affect your ability to get pregnant. Here, we list some commonly known types:

1. Total Hysterectomy:

This is when the whole of the uterus is removed. The surgery involves the removal of the uterus along with the cervix. The surgeon may or may not remove your ovaries and fallopian tubes during uterus removal. Total hysterectomy is the most common type of hysterectomy that gynecologists perform.

2. Partial or Subtotal Hysterectomy:

In this type of hysterectomy, the doctor will remove just the uterus, but not the cervix. In this kind of surgery too, the surgeon may or may not remove your ovaries.

3. Radical Hysterectomy:

The doctor will recommend a radical hysterectomy if you have cervical cancer. In this type of hysterectomy, the surgeon will remove your uterus, cervix, tissues on both sides of the cervix as well as the upper part of your vagina. Again, your ovaries and fallopian tubes may or may not be surgically removed.

In all these types of the hysterectomy procedures, the ovaries may or may not be taken out. The specific conditions that you have and the need for the hysterectomy will determine the need to remove the ovaries. In most cases, your healthcare provider will recommend removing ovaries only you are at a risk of developing ovarian cancer.

All women who opt hysterectomy will stop having their menstrual periods. This typically means that you cannot get pregnant. However, there are cases when women conceive after hysterectomy, but in a majority of cases, this is an ectopic pregnancy.

How Is Hysterectomy Performed?

A hysterectomy is performed in several ways. The method of hysterectomy that your doctor will choose for you will depend on your health history and the reason why the doctor is performing the surgery on you. The different options for performing the hysterectomy are:

1. Abdominal Hysterectomy:

Here, the doctor will make an incision in the lower abdomen to remove the uterus and other reproductive organs.

2. Vaginal Hysterectomy:

As the name suggests, the procedure occurs through the vagina. The surgeon will make a small incision near your vagina and after the procedure, he will seal it with an episiotomy.

3. Laparoscopic Hysterectomy:

A laparoscopic hysterectomy is performed using a laparoscope, which is a thin tube with light and camera at one end that helps the doctor to clearly see your pelvic organs and conduct the surgery without making too many cuts and incisions. During a laparoscopic hysterectomy, the doctor removes your uterus via small incisions in either your abdomen or vagina.

4. Robotic Surgery:

In this type of hysterectomy, the doctor uses a robotic arm to conduct the surgery through small cuts that are similar to those made during a laparoscopic hysterectomy [5].

Recovering from a hysterectomy takes some time. You may have to spend a couple of days at the hospital while some women are advised to stay longer. In any case, you should take lots of rest to recover fully. The doctors will advise to wait for about six weeks post the surgery to have sexual intercourse, during which period you are advised not to lift any heavy objects too.

Chances Of Pregnancy After Total And Partial Hysterectomy:

Generally speaking, hysterectomy will reduce your chances of getting pregnant to almost zero. However, there are women who become pregnant even after a hysterectomy.

In the case of a complete hysterectomy, pregnancy is next to impossible. The moment the surgeon removes your uterus, you will enter menopause. Since you will not experience egg production, there is no question of the egg being fertilized and you getting pregnant.

However, if it is a partial hysterectomy where your ovaries and fallopian tubes are intact, you may get pregnant, but the chances are extremely slim as the embryo will not have any place to implant itself since your uterus has been removed. This can increase the risk of ectopic pregnancy.

During a normal pregnancy, the ovaries release eggs. The sperm then fertilizes the egg, which implants onto the lining of the uterus and grows into a fully formed fetus. In women, who have had a hysterectomy, the uterus is partially or entirely removed.

In broad terms, people may understand that if there is no uterus, there can be no pregnancy. However, there are cases when this rule of thumb did not hold good. In these rare cases, the fertilized egg tends to attach itself to the fallopian tubes or even on the inside of the abdominal wall [6]. Of course, this will not be a viable pregnancy because there is no source of nourishment for the growing fetus. Many times when this happens, women don’t even realize that they are pregnant as the attached egg will die even before the woman realizes she may be pregnant. This typically means that even if a woman does get pregnant after hysterectomy; it might not be possible for the pregnancy to continue full-term.

No Uterus Means No Normal Pregnancy:

Under normal circumstances, if a woman does not have a uterus, she cannot have a healthy, full-term pregnancy. However, there is this minutest possibility of the egg, released during ovulation, getting fertilized and subsequently attaching itself to any other organ in the absence of the uterus. This type of pregnancy is referred to as an ectopic pregnancy and is usually life-threatening.

An ectopic pregnancy may lead to internal rupture of the fallopian tube or the internal organ that the fetus attaches itself to. As a result, it causes severe hemorrhage, which just a surgery can stem [7].

Ectopic Pregnancy After Hysterectomy:

With hysterectomy, the doctor removes your uterus totally or partially, and this makes pregnancy impossible. In extremely rare cases, about one in a million, pregnancy can occur even after hysterectomy [8]. This kind of gestation is an ectopic pregnancy, where the fertilized egg attaches inside the fallopian tube or inside the abdominal cavity.

An ectopic pregnancy after hysterectomy may occur only if the doctor doesn’t remove the ovaries and fallopian during total or partial hysterectomy. Ectopic pregnancies can be very scary because the woman who gets pregnant this way does not know about it in the initial few weeks. If the fertilized egg attaches to the fallopian tubes, ovaries, abdomen or even liver, it may continue to grow if it receives regular blood supply. Now, this can get dangerous as this may lead to rupture of the organ as the fetus grows.

Symptoms Of Pregnancy After Hysterectomy:

Most ectopic pregnancies do not have any prominent symptoms, and this makes it difficult to identify the condition and begin treatment at the earliest. Nonetheless, there are signs and symptoms that will take you to the ER and doctors will discover the pregnancy.

Light vaginal bleeding between periods- In women who have had a hysterectomy, this bleeding might be an early signal as women with hysterectomy should have a sort of menopause with no menstrual bleeding.

Another very significant symptom of an ectopic pregnancy is nausea and vomiting with blood and pain.

Severe abdominal pain and cramps.

Pain in the shoulder, neck, and rectum.

Extreme fatigue with dizziness.

If there is an internal rupture, the pain and bleeding can be severe enough to result in the woman fainting or feeling dizzy.

Diagnosing And Treating Ectopic Pregnancy After A Hysterectomy:

When you visit your medical practitioner with symptoms of ectopic pregnancy, the doctor will perform an ultrasound and pelvic examination. This will help the doctor view the condition of the abdomen and confirm the ectopic pregnancy.

In case your medical practitioner suspects an internal rupture, you will have an emergency surgery to terminate the pregnancy. In case your fallopian tube or ovaries have sustained damage due to the growing fetus, they will be surgically removed. If there is no rupture or damage to internal organs, the doctor may perform a laparoscopic surgery to remove the fetus and preserve the woman’s health from any life-threatening danger. Sometimes, the doctor may prescribe medications to stop the growth of the pregnancy tissue. This treatment method for ectopic pregnancy is used only when the pregnancy has not progressed very far, or the doctor identifies ectopic pregnancy at an early stage [9].

Is Pregnancy After Hysterectomy Possible?

Typically, after a hysterectomy, normal pregnancy is impossible. Your chances diminish even further if your ovaries and fallopian tubes are removed during the hysterectomy. Usually, doctors recommend removing ovaries as it reduces the risk of developing ovarian cancer later in life [10]. Hence, it can be emphatically said that pregnancy after hysterectomy is impossible.

If you want to experience motherhood after hysterectomy, you can opt for surrogacy, as long as you bank your eggs before the surgery. Surrogacy involves using your egg (or donor egg), fertilizing it with your partner’s sperm or donor sperm and then implant it into a surrogate, who will carry the fetus full-term. Alternatively, you can adopt a child.

In Conclusion:

Hysterectomy is a major surgery that results in life-changing circumstances. Getting pregnant after hysterectomy (ectopic or abdominal pregnancy) can spell even bigger problems for you. While pregnancy after a hysterectomy is rare, there is medical evidence to show it is a possibility. Hence, it is important to continue with contraception even after a hysterectomy that leaves your ovaries and fallopian tubes in place. Consult your OB/GYN to learn the best birth control measure for your situation to avoid unwanted and life-threatening pregnancy after hysterectomy.